1. Complex Rehab and the Current Reimbursement Decline: Ethical, Financial, and Clinical Decision Making for Optimal Outcome

2. Complex Rehab & the Current Reimbursement Decline: Ethical, Financial, and Clinical Decision Making for Optimal Outcome By Melissa Aitken, MPT & By Chip Fiske, CRTS, ATP

3. Complex Rehab & the Current Reimbursement Decline: Ethical, Financial, and Clinical Decision Making for Optimal Outcome I.What is Complex Rehab (defined by NCART)? It is the scope of practice that addresses each of following areas: Wheeled mobility Seating and alternative positioning Ambulation support

4. Complex Rehab & the Current Reimbursement Decline: Ethical, Financial, and Clinical Decision Making for Optimal Outcome Environmental controls to meet the physiologic and functional needs of people with disabilities

5. Complex Rehab and the Current Reimbursement Decline: Ethical, Financial, and Clinical Decision Making for Optimal Outcome Review of Complex Rehab ( PMD coding ) Group 1 - Light Duty (designed for intermittent use indoors) Group 2 - Basic Daily Mobility (designed for daily use indoors Group 3 - Complex Rehab (designed for complex disabilities- indoor use) Group 4 - Complex High Activity (designed for complex disabilities- indoor/outdoor use) Group 5 - Complex Pediatric (designed for pediatric clients)

6. Complex Rehab and the Current Reimbursement Decline: Ethical, Financial, and Clinical Decision Making for Optimal Outcome Medicaid Requirements for Complex Rehab CRTS to sign eval PT/OT to perform eval

7. Complex Rehab and the Current Reimbursement Decline: Ethical, Financial, and Clinical Decision Making for Optimal Outcome II.Ethical Decisions for Optimal Outcome Do no harm – Hippocratic Oath Provide compassion and respect for human dignity and rights through competent medical care Be honest in all professional interactions Shall support access to health care for all people

8. Complex Rehab and the Current Reimbursement Decline: Ethical, Financial, and Clinical Decision Making for Optimal Outcome III.Financial Decisions for Optimal Outcome Reimbursement decline Medicare Medicaid You reap what you sow Sowing good – result good referrals Sowing bad – result NO REFERRALS

9. Complex Rehab & the Current Reimbursement Decline: Ethical, Financial, and Clinical Decision Making for Optimal Outcome Why Employ an ATP in these tough economic times? Most current on insurance guidelines Most expedient in performing evals Produce better results = more referrals in long-run Most experienced in wheelchair/mobility evals

10. Complex Rehab and the Current Reimbursement Decline: Ethical, Financial, and Clinical Decision Making for Optimal Outcome IV.Clinical Decision Making for Optimal Outcome As an ATP (assistive technology practitioner) As a PT (physical therapist)

11. C Inappropriate fitting of wheelchairs can be costly As a Assistive Technology Practictioner…

12. Complex Rehab and the Current Reimbursement Decline: Ethical, Financial, and Clinical Decision Making for Optimal Outcome As a Physical Therapist… Remembering the focus is on: client centered vs. product driven not placing client in the NEWEST, GREATEST, and LATEST providing comfort for the patient

13. Complex Rehab & the Current Reimbursement Decline: Ethical, Financial, and Clinical Decision Making for Optimal Outcome Wheelchair Clinics Advantages of ATP/PT as team time efficiency for patient and staff less clinical errors better marketing for future business making partnership/better relationship with one another to build trust

14. Complex Rehab & the Current Reimbursement Decline: Ethical, Financial, and Clinical Decision Making for Optimal Outcome The crux of why certification for ATPs provides more assurance than those who dont? Validates individuals qualifications based by RESNAs standards Provide practice-related knowledge-based requirements against which an individual can be assessed

15. Seating is more than sitting

16. Complex Rehab & the Current Reimbursement Decline: Ethical, Financial, and Clinical Decision Making for Optimal Outcome

22. …AND THRIVING!